Children and AIDS – Getting to Zero

Last week’s International AIDS Conference was quite unlike the last to be held on US soil in 1990, at a time when the number of people living and dying with HIV was increasing rapidly and hope for a breakthrough seemed a distant prospect. But this week, the rhetoric, and more importantly, the reality were very different. Some eight million people now receive anti-retroviral medicines – one half of the people in need. The headlining message this year was “the end is in sight” and speeches were peppered with phrases like “AIDS free generation” and “the last mile.” But is such optimism justified? Have we really reached the beginning of the end of AIDS? The story regarding children and AIDS goes like this. Just twenty years ago, nearly one thousand children contracted HIV in the US. Less than a decade later, fewer than one hundred babies were born infected after mothers received anti-retroviral medicine. But replicating this remarkable achievement in developing countries has proven elusive. Only six percent of some five million pediatric infections worldwide were prevented by 2009. This year, over a quarter of a million children may become infected. To reach the “end of AIDS” with a goal of zero new pediatric HIV infections, bold new approaches are required with more emphasis on child-centered, family-focused and community-oriented programs.

Surprisingly, children have not been at the centre of most prevention of mother-to-child transmission efforts. In answering the question “Where is the child in vertical transmission campaigns” last week, I described how most exposed children are HIV-infected, dead or lost to follow-up rather than surviving, HIV-free and in contact with health services. Consequently, most children fail to receive lifesaving medicines, some costing as little as three cents per day. Few children are HIV tested and few mothers receive their child’s HIV test result. HIV transmission through breastfeeding now exceeds transmission taking place before or during birth  - in South Africa, it is three times higher. Reaching the end of AIDS requires children placed at the center of our efforts.

To do this, greater focus on the family is needed. Advocates avoid using the term “mother-to-child ” as stigmatizing, instead preferring the term “parent-to-child transmission.” Whatever the pros and cons of this, HIV is without doubt a family disease. Fathers are involved in the transmission of the virus to their infants as well as mothers. Men decide whether couples should have children, transmit infections to their wives, determine where the mother will deliver and how long she will breastfeed. Getting men to attend clinics for antenatal visits and encouraging couples to undergo HIV testing jointly are important prevention strategies because, in every sense, HIV is a family disease.

This blog was written by Geoff Foster, a health expert and pediatrician with over 20 years experience in Zimbabwe. He is also a Firelight Foundation Board and Advisory Council Member. Read more about Geoff here.